Treatment of Patients with Small Cell Lung Cancer in Routine Clinical Practice: 10 Year Trend of Treatment Strategies and Overall Survival

ABSTRACT Introduction Treatment of patients with small cell lung cancer (SCLC) is challenging due to the generally poor prognosis of the disease and the lack of new treatment options. There are few data on how delivered treatment has changed during the past decade in routine clinical practice and how this has effected overall survival. Methods We retrospectively analyzed all patients diagnosed with SCLC at our institution (lung cancer center certified by the German Cancer Society (DKG)) since 2002. Analysis included lines of treatment delivered, progression free survival (PFS) at each therapy line, use of radiotherapy, overall survival (OS), and use of PET-CT. Results Preliminary analysis included 102 patients, of which 41 % had limited disease (LD) and 59 % had extensive disease (ED). For all patients, platinum doublet with etoposide has remained standard first line therapy. For patients with LD, the use of simultaneous thoracic radiochemotherapy replaced sequential chemotherapy followed by thoracic radiotherapy. In order to achieve a smaller radiation field, simultaneous radiochemotherapy was usually preceded by 2 cycles of chemotherapy. For patients with extensive disease, the use of cisplatinum instead of carboplatin increased in good performance status patients due to improved antiemesis (apprepitant). As second line therapy, oral topotecan has largely replaced EpiCO (epirubicin, cyclophosphamide, vincristin). One patient with early recurrence of brain metastasis after radiotherapy and topotecan was treated successfully with oral temozolomide. Since August 2007, all ED patients responding to first line therapy received prophylactic cranial radiation. OS tended to increase throughout the study period (LD: from 14 to 17 months, ED: from 6.7 to 10.1 months). Conclusions New treatment options were successfully implemented in routine clinical practice and resulted in improved survival. However, survival remains unsatisfactory emphasizing the need for early detection and development of additional treatment strategies. Disclosure All authors have declared no conflicts of interest.